• Member Services Advocate

    Convey Health Solutions (Fort Lauderdale, FL)


    Job Description

    OVERVIEW

    This is for temporary role of Member Service Advocate. Member Services Advocate will receive inbound calls from members enrolled in Cigna. Assist beneficiaries with a wide range of critical services, which include but not limited to updating account information, providing plan information, resolving issues with utilization of the plan. Place outbound calls as directed and necessary for member resolution.

    ESSENTIAL DUTIES AND RESPONSIBILITIES

    + Update account information such as billing options and changes of address or phone numbers.

    + Research premium billing discrepancies and prescription claims processed.

    + Educate beneficiaries on how the plan works, including benefits, cost sharing, and levels of coverage.

    + Submit mail requests for beneficiaries such as ID cards and formularies.

    + Look up medicines on the formulary to verify if they are covered, the tier and copay level, and if a drug is not covered, provide an explanation as to why.

    + Displays positive demeanor, technical accuracy, and conformity to company policies.

    + Understands CMS Guidance and ensures the mailing of applicable Exhibits per CMS Guidance.

    + Follow HIPAA regulations within the immediate environment.

    + Responsible for concise and detailed notations as it pertains to member records.

    + Handles outbound calls for purposes of validating information.

    + Handles inbound calls by assisting members with a high level of accuracy and efficiency.

    + Escalates any member issues to management as necessary.

    + Responsible for maintaining a high level of call quality as set by client standards, which includes a 95% quality score, and answering 80-85% of calls within 30sec or less

    + Communicate with coworkers, management, staff, customers, and others in a courteous and professional manner.

    + Conform with and abide by all regulations, policies, work procedures and instructions.

    + Respond promptly when returning telephone calls and replying to correspondence and faxes.

    EDUCATION AND EXPERIENCE

    + High school diploma or equivalent. Associate Degree is preferred. Degree in Healthcare preferred.

    + Minimum 2 years working in a fast paced high volume call center environment, retail customer service, preferably in healthcare or hospitality

    + Above average computer skill is required, including the ability to work in a Windows environment and multitask within multiple software programs simultaneously.

     

    About Us

    WHO WE ARE

    Convey Health Solutions manages a myriad of administrative needs and make it easier for health plans to operate and provide valuable experiences for their members. How so? We focus on building specific technologies and services that uniquely meet the needs of government-sponsored health plans.

    OUR MISSION

    To improve health plan operations and elevate the customer experience.

    OUR VISION

    Empowering health plans to excel through technology, service and advisory experience.

    OUR VALUES

    Integrity First - Inspired Teamwork - Compliance Matters